Gynecology And Obstetrics-

Premature labor

Definition

Premature labor refers to efforts to give birth before the 37th week of pregnancy, i.e. up to and including 36 + 6 due to labor. This is the limit for premature birth.

frequency

1:30 - 1:50 births, involved in approx. 30-50% of all premature births (Premature labor).

Pathogenesis

The making of Labor pains (premature labor) is the body's own hormones, the Oxytocin and Prostaglandins, basically. Oxytocin is used in the Hypothalamus formed and leads to by binding to receptors Contraction of the uterus (=uterus). In the course of the pregnancy there is an increase in the receptors in the uterine muscles, so that sensitivity increases.

The pathogenesis of local infections lies in the formation of an endogenous hormone, des Prostaglandinswhich, on the one hand, leads directly to uterine contractions (= Labor pains) by activating the smooth muscles on the other hand, it also softens the cervix so that it opens. The cervix is divided into an inner and an outer cervix and thus frames the cervix (=Cervical canal). It opens outwards into the vagina and inwards into the uterus. The softening and thus easier opening is a natural process under the birth. The formation of prostaglandins occurs through the increased release of an enzyme, the phospholipase A2, during an inflammatory reaction. This then leads to an increased synthesis of arachidonic acid, which in turn is converted into prostaglandins (premature labor).

The pathogenesis of the Induction of labor (Premature labor) in multiple pregnancies and polyhydramnios is due to the fact that the muscle layer of the uterus (= myometrium) is stretched too far.

root cause

There are many reasons for premature labor to occur. Infections are most commonly involved. These can be generalized infections (such as urinary tract infections) or fever, but also local infections such as inflammation in the vagina (= colpitis), in the cervix (= cervicitis) or in the uterus directly (= intrauterine).

Mental / physical overload or certain foods are also mentioned as reasons for premature labor.

Read more on the subject below Prohibited foods during pregnancy.

A multiple pregnancy or problems with the placenta (=placenta), which can be placental insufficiency as well as placental detachment.

A calcified placenta can also lead to premature labor. Here, the reduced blood supply to the fetus and its insufficient supply of nutrients via the placenta is the decisive reason for the induction of labor. Read more on the subject below: Calcified placenta

Too large a quantity of amniotic fluid (= polyhydramnios) can also be considered as a cause of premature labor.

Symptoms

Depending on the week of pregnancy, there are normal values, what kind of Labor pains (premature labor) and how many per day or per hour are considered normal. Increased occurrence speaks for premature labor, this can include relatively unspecific symptoms such as Back pain, Pulling in the stomach, Hardening of the abdomen or altered discharge come.If only cramps occur without pain or discharge, it may just be Exercise contractions act.

Up to are normal 10 contractions in 24h, less than 3 contractions per hour up to the 30th week of pregnancy, less than 5 contractions above that. From the 20th week of pregnancy, uncontrolled, weak contractions (so-called Alvarez waves up to 20 mmHg) or uterine contractions of up to 30 mmHg with subsequent pause in labor (=Braxton-Hicks contractions) come (premature labor).

How can you recognize premature labor?

Usually a pregnancy lasts 40 weeks. During this time, the body is increasingly preparing for the impending delivery, including the uterus. The uterus (also called the uterus) is an organ that is completely surrounded by a thick, strong layer of muscle. This muscle layer ultimately creates the labor activity on the due date and enables the child to be expelled by contracting.
In order for this process to be fully developed on the delivery date, the uterus leads from around the 20th to 25th. Week of pregnancy through the so-called Braxton-Hicks contractions. This is it Exercise contractionswhich one kind Training for childbirth represent. In most cases, they are relatively painless, short-lived, and irregular. Furthermore, premature labor is said to be ineffective because it has no effect on the opening of the cervix. Most women describe the labor pains as brief hardening of her stomachthat last for about a minute. Exercise contractions are completely harmless and not a cause for concern.
A distinction is made between them Pangs, which usually occur from the 36th week of pregnancy and a type Represent rehearsal for the birth. Here the pregnant woman feels a violent Drawing in the abdomenwhich can even radiate into other parts of the body. Many women feel this Pulling in the back too or in the Groin. There the stomach hardens just like the practice contractions. Real pain, on the other hand, is rarely felt during pre-contraction. The distancesin which the premature woes occur are mostly irregular and the drag is not permanent. This type of contraction also gives no indication of a possible premature birth; she is perfectly normal.
This is often followed by the so-called Labor pains on. As the name suggests, this is the Lowering of the child's head deep into the pelvis. This process can be classified around the 36th week of pregnancy. In contrast to the types of contractions described so far, this is painful labor. But they also have an advantage: Because the child is now deeper in the pelvis, the Ingestion for the pregnant woman again from now on significantly lighter.

These are completely normal types of contractions Early labor that can occur at any stage of pregnancy.
Unfortunately, early contractions are not harmless and can mean that the body has the Initiate the birth process prematurely tries. Basically they are very similar to the other types of contractions, but they mostly occur more often and with increasing intensity on. If premature labor occurs more than three times in an hour and this occurs before the 36th week of pregnancy, it is advisable to do so as soon as possible Contact the gynecologist or to the responsible midwife.
Another clue for pre-contractions is one that occurs in addition to contraction vaginal watery or bloody discharge. With early contact with a doctor, however, in many cases it is possible to use medication, bed rest or the like. prevent premature delivery.

diagnosis

The physical exam to assess premature labor is vaginal palpation. The Length of the cervix, the The width and consistency of the cervix and the palpable part of the child. Then it is done with the vaginal Ultrasonic measured the length of the cervix (Standard: 3.5-5cm) and assesses whether a so-called funnel has formed. This speaks for an upcoming birth.

To the Exclusion of infection a smear is taken, both for bacteria and for Chlamydia and Mycoplasma. Likewise the PH value The discharge is determined (norm: 4, in the case of rupture of the bladder: more basic = higher, around 8, which increases the risk of premature birth) and a special test Rupture of the bladder locked out.

At a Blood draw will be the parameters of inflammation (White blood cells and CRP) intended to rule out an amniotic infection. Also the urine Wil be inspected.

Furthermore, a Cardiotocogram (CTG) recorded with the child's heart action and the contractions of the uterus. An ultrasound is done to assess the child's health.

Guideline for the treatment of premature labor

Medical guidelines represent a kind red thread designed to assist medical staff in making decisions in specific clinical situations.
Stepping on a pregnant woman premature labor (Pre-labor) from the 24th week of pregnancy on, is performing a Tocolysis (Contraception) recommended.
This is intended to Contractions for at least 48 hours be canceled in order to have the option of a Lung maturation in the kind to perform. Lung maturation is achieved with a single dose of betamethasone injections into the muscles. The aim is to prepare the unborn child's still immature lungs for a possible premature birth.
Should the premature labor before the 24th or after the 33rd week of pregnancy occur, tocolysis is not recommended according to the guideline.

therapy

Depending on the findings, the therapy for premature labor is divided into outpatient care, inpatient care and Delivery indication. This is provided if the mother and / or child are at risk. This would apply to clinical pictures such as Placental insufficiency or -solution, (Pre-)Eclampsia or Amniotic infection.

If infection is detected, the Infection remediation (e.g. with a antibiotic) in the foreground about the cause of the Labor pains (premature labor), too high a pH is acidified by vaginal suppositories.

Outpatient treatment

With the following findings, a outpatient care occur:

in the CTG less than 6 contractions per hour
no change in the length of the cervix
no evidence of a rupture of the bubble

After clarification of the symptoms premature labor If the baby is threatened with premature birth (the abdomen becomes hard, the back or the groin is pulled), the patient can be discharged into the home environment. Then there is one incapacity for work with much (Bed rest, Domestic help may be provided by the health insurance company. 3 times a day should take 2 tablets of Magnesium 5-Longoral / per day (= 30mmol Mg), because magnesium has a relaxing effect on the muscles. The check-ups are more closely meshed than in normal pregnancy.

Inpatient treatment

A hospitalized for the treatment of premature labor is necessary if:

Cervical length (= cervix length) shortened (less than 2.5 cm)
Regular, painful labor
Symptoms occur before the 32nd week of pregnancy or an estimated child weight <1500g (admission to a neonatological center)

The important thing is possible Stressors off in order to eliminate the possible cause. Furthermore, between the 24th and 34th week of pregnancy a drug lung maturation (=IBS prophylaxis) of the fetus carried out around when an incoming Premature birth improve the newborn's chances of survival. In these circumstances the Labor to inhibit (premature labor) with various drugs (=Tocolysis). However, this does not reduce the rate of premature births, but rather leads to a short-term inhibition in carrying it longer by approx. 2-7 days (premature labor).

Medicines used to treat premature labor

Betamimetics: These are the best researched and the most used. An example of this is Fenoterol or the trade name Partusists. This must not be used for Heart, liver, kidney diseases, lung infection, Hyperthyroidism and to high levels of potassium in your blood. Therefore, this must also be done daily during therapy blood and the Blood pressure to be controlled.
magnesium: magnesium is now controversial in use, an effect compared to placebos could not be shown in studies. A general widening of the vessels results in Drop in blood pressure, a headache, blush, dizziness. If high doses accumulate in the unborn child, it can become one Hypermagnesaemia come with influencing the breathing movement and heart action.
Calcium antagonists: Calcium causes the phosphorylation of myosin chains (= microscopic structure of a muscle) and thus causes the muscles to contract. Calcium antagonists reduce the calcium concentration in the cell and there are fewer contractions. However, it is not approved as tocolysis, but it has effects equivalent to those of the other drugs. Side effects result from a lowering of the blood pressure by widening the vessels, which leads to an acceleration of the heart rate (=Tachycardia), Headache, dizziness or nausea (premature labor)

Oxytocin antagonists: The mechanism of action is that the drug attaches itself to the receptors of the oxytocin, so that the oxytocin itself no longer has any space and cannot develop any effect (premature labor). The means used is called Tractocile. The general indication is Diabetes mellitus or Gestational diabetes, Twin pregnancy, hypertension or premature rupture of the bladder. The effectiveness is no better than that of fenoterol, but it is better tolerated (no observation of cardiovascular side effects) and also significantly more expensive. To be used in place of betamimetics, a Cervical opening of 1-3 cm, one regular uterine contraction of more than 30 seconds and at least 4 times / 30min, a cervical lapse of more than 50%, Age> 18 years, the Pregnancy is between the 24th and 33rd week of pregnancy located and a normal fetal heart rate.

Homeopathic treatment for premature labor

The use of homeopathic remedies to treat premature labor is a principle of therapy whose effectiveness scientifically not proven and which should never be done without consulting the gynecologist or the supervising midwife.
Some women report a positive effect of the Bryophyllums. These are tablets or powders that should be taken three times a day. Besides the contraceptive effect will too Effects on the psyche as well as sleep irregularities. However, you should start taking it never without the consent of the doctor respectively.

How can you avoid premature labor?

Usually, premature labor can be done successfully some days of bed rest and Relaxation being stopped.
Often they are caused by excessive physical or mental exertion. Most doctors also recommend that you stop completely for some time Refrain from intercourseas this can also cause premature labor.
Furthermore, it is not uncommon Magnesium pills prescribed that cause the muscle layer of the Uterus can relax again and the contractions are reduced or stopped.
A prophylaxis for premature labor unfortunately does not exist. But basically it is helpful to take good care of yourself and to listen to your own body. Pregnant women should neither lift heavy, still take on extraordinary physical strain. The period of pregnancy is a time when you can sometimes accept help from family or friends.